Chan Lai Fong, Woon Luke Sy-Cherng, Mohd Shukor Nuur Asyikin, Eu Choon Leng, Ismail Nurazah, Chin Song Jie, Nik Jaafar Nik Ruzyanei, Baharudin Azlin
Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia.
Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia, Kuala Lumpur, Malaysia.
Front Psychiatry. 2022 Jul 22;13:890099. doi: 10.3389/fpsyt.2022.890099. eCollection 2022.
A significant proportion of patients with treatment-resistant depression do not attain functional recovery despite administration of multiple steps of pharmacotherapeutic strategies. This highlights the elusiveness of meeting unmet needs in existing pharmacotherapies for treatment-resistant depression. There is accumulating evidence that antidepressant agents involving the glutamatergic system such as brexpiprazole and esketamine/ketamine have more rapid onset of action and potentially improved effectiveness as an augmentation therapy in treatment-resistant depression. This case series aimed to report five complex cases of unipolar and bipolar treatment-resistant depression where conventional treatment strategies were inadequate in managing high risk suicidal behavior and achieving functional recovery. We discussed further the possible synergistic mechanisms of the novel combination strategy of brexpiprazole and esketamine/ketamine, clinical and patient factors that influenced treatment response, challenges with this combination strategy and implications for future practice and research.
相当一部分难治性抑郁症患者尽管采用了多步骤药物治疗策略，但仍未实现功能恢复。这凸显了在现有治疗难治性抑郁症的药物疗法中满足未满足需求的难度。越来越多的证据表明，涉及谷氨酸能系统的抗抑郁药，如布雷哌唑和艾司氯胺酮/氯胺酮，起效更快，作为难治性抑郁症的增效疗法可能有效性更高。本病例系列旨在报告5例单相和双相难治性抑郁症的复杂病例，在这些病例中，传统治疗策略在管理高风险自杀行为和实现功能恢复方面并不充分。我们进一步讨论了布雷哌唑与艾司氯胺酮/氯胺酮联合新策略可能的协同机制、影响治疗反应的临床和患者因素、该联合策略面临的挑战以及对未来实践和研究的启示。
